Utilizing community resources to treat PTSD: A randomized controlled study using Thought Field Therapy.

Full text

African Journal of Traumatic Stress Vol 3 No1 June 2013
82
*Correspondence:
Suzanne M Connolly
Sedona, Arizona, USA
Utilizing Community Resources to Treat PTSD:
A Randomized Controlled Study Using Thought Field Therapy
Suzanne M Connolly1, Dominique Roe-Sepowitz2, Caroline Sakai3, Jenny Edwards4
1. 1 Sedona, Arizona, USA 2 Arizona State University, Phoenix, Arizona, USA 3 Honolulu
Hawaii, USA 4 Fielding Graduate University, Santa Barbara, California, USA
Abstract
The use of Thought Field Therapy (TFT), a brief therapy technique, is examined in a randomized
controlled study, to determine if there is a signicant difference in the reduction of trauma symptoms
between the treated group and the untreated group. Study participants in the waitlist group received
treatment after having completing the posttest.
Prior to the study, TFT techniques were taught to Rwandan community leaders, who then provided
one-time individual trauma-focused TFT interventions to one hundred and sixty four adult survivors
of the 1994 Rwandan genocide in their native language, Kinyarwanda. Pre- and post-intervention
assessments of trauma symptoms used were the Trauma Symptom Inventory (TSI) and the Modied
Posttraumatic Stress Disorder Symptom Scale (MPSS) translated into Kinyarwanda. Signicant
differences were found in trauma symptoms and level of PTSD symptom severity and frequency
between the treatment and the waitlist control groups. Participants in the waitlist group experienced
signicant reductions in trauma symptoms following their subsequent treatments, which took place
after the rst posttest. These positive outcomes suggest that a one-time, community leader facilitated
trauma-focused TFT intervention may be benecial with protracted PTSD in genocide survivors.
Key words: Community Resources, PTSD, Rwanda, Thought Field Therapy, Trauma Treatment
Keywords:
AJTS June 2013 3(1): 00-00
Introduction
A growing body of literature speaks to the need
for addressing psychological trauma after large-
scale disasters wherever and however they might
occur (Ghosh, Mohit, & Murthy, 2004). The effects
of conict and war are especially devastating in
an age where 90% of the casualties of war are
civilians (Alexander, 2010). Restoring social stability
after mass trauma can challenge the resources of
even developed nations. Due to severely limited
resources, many developing nations face still greater
challenges. Yet, inhabitants of developing nations
are more likely to, at some time in their lives, be
directly affected by conict. They are also likely
to suffer greater losses due to the ravages of
natural disasters such as earthquakes and oods,
and man-made disasters such as war and conict
(Desjarlais, Eisenberg, Good, & Kleinman, 1995;
Goush et al. 2004).
Lingering psychological effects of trauma often go
untreated years after an initial disaster, war, or conict
has ended. In a review of 192 studies of Posttraumatic
Stress Disorder (PTSD) conducted between 1980 and
2005, Galea, Nandi, and Vlahov (2005) noted that
several studies have provided evidence that in many
people, trauma symptoms can persist long after the
traumatic event.
This study examined the use of Thought Field Therapy
(TFT) for the treatment of Posttraumatic Stress Disorder
after a large-scale traumatic event. Prior research
efforts have suggested that TFT could possibly be
helpful in addressing long-standing symptoms of PTSD
in individuals living in developing nations following
large-scale traumatic events. (Connolly & Sakai,
2011; Sakai, Connolly, & Oas, 2010). TFT is a self-
help treatment that can be easily disseminated through
the development of community-based partnerships
of trained mental health practitioners and trained
community leaders. The practical constraints of this
eld study dictated the utilization a single treatment
session using a waitlist control group design.
Rwandan genocide survivors
The symptoms of trauma experienced

African Journal of Traumatic Stress Vol 3 No1 June 2013
83
by survivors of the 1994 genocide in Rwanda
have been well documented. One and a half
years after the 1994 genocide, Neugebauer
et al. (2009) conducted interviews of Rwandan
children and adolescents. They found that, as in
studies of traumatized children and adolescents in
industrial societies, child and adolescent survivors
of the Rwandan genocide reported experiencing
symptoms of trauma, including intrusive memories,
hyper-arousal, avoidance, and emotional numbing.
Neugebauer et al. noted that, of the total of 1547
individuals aged 8-19 years who participated in
interviews, over 90% reported exposure to life
threat and witnessing killings.
Psychological intervention following large-scale
trauma
Hobfoll et al. (2007) assembled a world
panel of experts on the study and treatment of
those exposed to large-scale trauma in an effort to
form a consensus on intervention strategies. These
experts concluded that “the scale of recent disasters
and incidents of mass violence also underscores
that these interventions must be available to large
numbers of individuals, at levels that quickly outstrip
the available individual-level therapists who are
local or may be dispatched to the region” (Hobfoll
et al., 2007, p. 301). These authors emphasize
that therapeutic intervention that can be used as
self-help tools can increase the individual’s sense
of self-efcacy, an important aspect of the trauma
recovery process.
Desjarlais et al. (1995) listed 13 studies of
prevalence rates of PTSD after large-scale disasters
in 11 countries and identied prevalence rates from
4% to 88%. These authors noted that in the face of
profound challenges, the World Health Organization
and the international mental health community had
developed a general consensus on basic principles
that could serve to guide those seeking to improve
mental health services. These authors noted that
presently, few who live in disaster-prone areas
receive needed mental health services.
Recognizing the need for addressing
mental health needs after large-scale disasters
and conict, the Executive Board of the World
Health Organization met in Geneva in 2002 and
recommended support for the implementation of
programs to address the psychological damage of
war and natural disasters (Ghosh et al., 2004). In
2003, the World Health Organization, Department
of Mental Health and Substance Dependence (2003),
issued a document recommending maximizing
resources within communities and specifically
educating community leaders in core psychological
care skills. The Inter-Agency Standing Committee
(IASC) (IASC, 2007) completed guidelines for the
implementation of such programs. The rst and
third authors of the present study have responded
to invitations to work in Rwanda on ve separate
occasions (for approximately one month each year
from 2006 through 2010), providing interventions
within guidelines compatible with those suggested
by IASC. These efforts are under the third tier
of emergency relief efforts as dened by IASC.
According to guidelines, after basic needs for
services and security (rst tier), and community
and family support (second tier) have been
implemented, there remains for some (but certainly
not all) who have been affected by disaster, a need
for focused non-specialized support. This third tier
represents the support that a smaller number of
people might still need after the basic needs for
security, safety, and community and family support
have been met. According to these guidelines, this
third tier of care can consist of psychological care
provided by community workers, as psychological
rst aid. Persons not responding sufciently to
this level of intervention could then be referred
to mental health professionals within the local
mental health community (tier four), saving scarce
professional resources for those who remain in need
of more specialized services (IASC, 2007).
In the case of the community targeted in
the present study, this third tier of services was
provided to persons in Rwanda who had been
in Rwanda in 1994 and who stated that they
continued to experience symptoms of trauma,
15 years after the 1994 genocide. In this study,
respected community leaders, who attended a
two-day training in Thought Field Therapy (TFT),
and who were not for the most part mental
health professionals, administered all therapy
interventions.
Literature review of Thought Field Therapy
In one non-randomized controlled pilot
study, 29 low-income refugee and immigrant high
school students living in the United States were
categorized as having the symptoms of PTSD
based on exceeding a cut-off score on the Civilian
Posttraumatic Checklist-C (PCL-C) (Weathers,
Huska, & Keane, 1991). After one to three sessions
of TFT, their PCL-C scores showed signicantly less

African Journal of Traumatic Stress Vol 3 No1 June 2013
84
avoidance behaviors (p < .05), intrusive thoughts (p
< .05), and hyper vigilance (p < .05) than prior to
treatment (Folkes, 2002).
In another non-randomized controlled
preliminary study, Sakai et al. (2010) treated 50
adolescents who were orphaned by the Rwandan
genocide and were experiencing PTSD symptoms
as measured by the Child Report of Post-Traumatic
Stress (CROPS) and the companion testing instrument,
Parent (guardian) Report of Post-Traumatic Stress
(PROPS) (Greenwald & Rubin, 1999). Adolescents
and caregivers reported signicant decreases in
PTSD symptoms in the children after one TFT session.
These improvements were sustained at the one-year
follow-up.
In a randomized controlled study, with a two-
year follow-up, Connolly and Sakai (2011) tested the
use of TFT by trained community leaders to address
symptoms of trauma after a large-scale conict.
They examined the efcacy of TFT administered by
community leaders in reducing Posttraumatic Stress
Disorder symptoms in adult survivors of the 1994
genocide in Rwanda. TFT signicantly reduced
trauma symptom scores on the Trauma Symptom
Inventory (TSI) (Briere, 1995) and the Modied PTSD
Symptom Scale (MPSS) (Falsetti, Resnick, Resnick, &
Kilpatrick, 1993) for the treatment group. The wait-
control group was treated two days after the posttest
and then took a second posttest a week later. In the
wait-control group, TFT signicantly reduced trauma
symptom scores on the Trauma Symptom Inventory
and the Modied PTSD Symptom Scale. Posttests
administered two years following the treatment
indicated that treatment effects endured for both
the original treatment group and the treated waitlist
control group.
In this study, local community leaders
received a two-day intensive training in TFT prior to
the intervention. The trained community leaders were
supervised during the intervention by the trainers as
they administered TFT. This study aimed to determine
if participants, guided by TFT-trained community
leaders in using TFT self-treatment techniques,
demonstrated trauma symptom reduction greater
than those receiving no treatment on measures of
PTSD-specic trauma symptoms, seven days post
TFT treatment, and to determine if the wait-list
control group would show changes after subsequent
treatment.
METHODS
Participants
Participants were  adult survivors of the
1994 genocide in Rwanda recruited by a Catholic
priest of the Nyinawimana parish of the diocese of
Byumba, Rwanda who announced the call for volunteers
at church services and public meetings in the larger
community. The rst  persons who were over 18
years of age and who reported that they currently
were experiencing psychological symptoms related
to trauma were accepted. Of the 199 voluntary
participants 35 were removed due to a score of 75
or above on the Inconsistent Response (INC) scale for
reliability/validity on the TSI (judged by the scale
creators to be invalid). The test author points out that
some individuals experiencing extreme trauma may
have difculty, such as shortened attention span and/or
dissociative symptoms, and that testers should examine
the possibility that high INC scores are explainable for
other reasons other than inconsistency per se., in which
case the tests could be considered valid. (Briere, 1995,
p.12). However in this test situation it was not possible
to evaluate tests individually following this criterion,
so all tests with high INC scores were eliminated. The
nal sample of 164 participants ranged in age from
18 to 100 (M = 47.7, SD = 14.8), and all volunteered
to receive a brief treatment for symptoms of trauma.
The test was administered with the help of community
leaders as all participants in the study, with the
exception of one participant, were unable to read
at the level required to self-administer the testing
instrument. The participants all spoke Kinyarwanda,
the language in which the consent forms and testing
instruments were translated. All participants reported
at the time of volunteering for the study that they
suffered from symptoms of trauma related to the
1994 Rwanda genocide. The Arizona State University
Institutional Review Board and the Republic of Rwanda
National Ethics Committee approved this study.
The majority of the participants were female
(141, 86%; male 23, 14%). The participants were
native to many regions of Rwanda, with the largest
proportions from Byumba (155, 94.5%). Other
participants were native to Butare (1, .6%), Gitamara
(1, 6%), Kigali (1, .6%), and other (6, 3.7%).
Reported experiences during the 1994
genocide included: being beaten, 43 (26.2%); having
been abused, 52 (31.9%); witnessing others being
beaten, 97 (59.1%); witnessing others being killed,
112 (68.3%); hearing others being hit or beaten,

African Journal of Traumatic Stress Vol 3 No1 June 2013
85
Measures
The participants completed a demographic
form including age, gender, birth region, questions
about what they experienced and/or saw during
the genocide, along with two trauma-focused
instruments, the Modied PTSD Symptom Scale
(MPSS) (Falsetti et al. 1993), and the Trauma
Symptom Inventory (TSI) (Briere, 1995). The
instructions for each pretest and posttest were
verbally modied to assess how often the symptoms
had appeared in the last week.
The MPSS (Falsetti et al., 1993) was used
to assess the existence of PTSD and the frequency
and severity of the PTSD symptoms. Scoring criteria
for experiences of PTSD as determined by the test
developers were a 23 or above on frequency, a
47 or above on severity, and a 71 or above as a
sum.
The full 100-item TSI, created by Briere
(1995) to assess symptoms that trauma victims
experience, was also used in the study. The scores
of each TSI subscale were summed and converted
into a t-score by the scoring program. Changes
between pretest to posttests for each symptom
were examined within each group, as well as
between the two groups. A total of 164 pretest
and posttest TSIs were included in the study. Thirty-
ve completed TSIs (21%) were excluded from the
study due to very high scores (above 75 t-score) on
the Inconsistent Response subscale and the authors
had no way to assess these test-takers’ scores on
an individual basis to see if the high INC scores
reected explainable responses as test developer
recommends.
The internal consistency of the TSI has been
supported with Cronbach’s (Cohen, 1988) alphas
ranging from .74 to .91 (mean α = .86) for each
subscale. For the present study, the Cronbach’s
alphas for the subscales were Anxious Arousal
(.86), Depression (.83), Anger/Irritability (.89),
Intrusive Experiences (.90), Defensive Avoidance
(.72), Dissociation (.84), Sexual Concern (.84),
Dysfunctional Sexual Behavior (.65), Impaired Self-
Reference (.76), and Tension Reduction Behavior
(.58). All instruments were professionally translated
from English to Kinyarwanda, the rst language of
most Rwandans, by a native Rwandan. They were
then back-translated to English by a native speaker
of English.
118 (71.9%); and being forced to do things they
were against, 40 (24.4%). Eighty-three (50.6%) of
the participants reported that they had previously
sought treatment for the problems they had
experienced since the genocide of 1994. By having
been in Rwanda during the genocide of 1994,
all participants met the DSM-IV criterion A1 for
Posttraumatic Stress Disorder (American Psychiatric
Association [DSM-IV-TR], 2000).
Intervention
The intervention used in this study was
Thought Field Therapy, a psychological treatment
intervention developed by Roger Callahan, a
psychologist (Callahan & Callahan, 2000). A
modied version of the standard TFT algorithm
training manual was used throughout the study.
The manual was translated into French, the written
language with which the Rwandan trainees were
most familiar, and was also available in English
for those Rwandan trainees who preferred English.
The manuals (unpublished) used can be viewed or
downloaded from http://thoughteldtherapy.net/
manual/. Although there are more advanced levels
of TFT that require more extensive training, only the
TFT algorithms were taught and applied in this study.
The scope of this paper will be limited to the efcacy
of TFT at the algorithm level to address symptoms
of trauma.
Rwandan therapists
The community organizer-priest, the primary
contact, selected the 36 Rwandan therapists. The
selected therapists included respected community
leaders from the Byumba and Kigali regions
of Rwanda and all spoke the native language,
Kinyarwanda. The selected therapists also spoke
French and/or English. The training took place at
the Izere Center (Center for Hope), in the Northern
District of Rwanda.
Treatment protocol
The trainers were available for supervision
throughout the entire study, ensuring that the
newly trained Rwandan therapists adhered to the
standard TFT algorithm protocols throughout the
treatment phases of the study. The Rwandan trainees
received two days of training, including training in
condentiality, the stages of trauma intervention,
and training in TFT algorithm protocols.

African Journal of Traumatic Stress Vol 3 No1 June 2013
Design and procedures
A randomized, waitlist control group design
was used. After reading the consent letter, and
agreeing to participate in the study, participants
were randomly assigned to an immediate treatment
group or the waitlist control group. Blank surveys
were in le folders delineated as treatment (blue
folders) or waitlist control group (red folders)
and were stacked alternately. The intake person
took the top le from the stack and assigned the
participant to that group and continued with the
alternating group assignments. The person handing
out the folders was not aware of the implications
of the different colored folders. All participants
completed the demographic form and pretests
(MPSS and TSI). Those assigned to the treatment
group returned two days later for treatment with
TFT from a randomly assigned newly trained
Rwandan therapist. The treatment group and the
waitlist control group were asked to return seven
days later to complete the posttests. The waitlist
control group received treatment with TFT two days
following the posttest and returned seven days after
their treatment to take a second posttest. The tests,
except for one, were administered interview-style
with the help of the Rwandan therapists in private
one-to-one settings for all participants except for
the one participant who could read the testing
materials. The immediate treatment group
was compared to the waitlist control group one week
following their treatment with TFT to determine if the
TFT treatments would produce changes greater than
no intervention. The waitlist control group received
treatment with TFT two days following the comparison
assessment. The mean duration of the intervention
for all participants was 35 minutes, and ranged from
5 to 120 minutes.
RESULTS
Participants’ symptoms
Seventy-three participants (44.5%) attained
86
TABLE 1
Pretest Mean Scores for Treatment and Waitlist Control Group
Treatment Group
(n=85)
Waitlist Control Group
(n=79)
Measure M SD M SD t p
Trauma Symptom Inventory Pretest
Anxious Arousal* 67.4 10.5 63.7 11.4 -2.13 0.035
Depression* 67.3 9.9 63.2 11.1 -2.45 0.015
Anger/Irritability* 59.3 12.1 54.8 10.8 -2.47 0.015
Intrusive Experiences 68.9 11.2 66.0 11.7 -1.34 0.1
Defensive Avoidance 60.3 9.9 57.5 8.1 -1.98 0.05
Dissociation 69.4 13.1 65.5 13.1 -1.92 0.05
Sexual Concerns 61.8 14.2 58.7 13.6 -1.4 0.15
Dysfunctional Sexual Behavior 57.1 11.8 54.8 12.6 -1.21 0.23
Impaired Self-Reference* 64.5 9.7 60.7 9.7 -2.5 0.013
Tension Reduction Behavior 61.8 11.9 59.1 12.1 -1.44 0.15
MPSS Pre-test
Frequency 29.1 9.1 26.7 10.4 -1.61 0.11
Severity 38.2 15.8 34.0 16.4 -1.68 0.096
Sum 67.4 23.2 60.7 26.1 -1.74 0.085
* signicant at p < .05.

African Journal of Traumatic Stress Vol 3 No1 June 2013
the PTSD cutoff score of 71 or above on the sum of
their pretest MPSS frequency and severity subscales.
PTSD sum scores on the pretest MPSS ranged from
0 to 114 (M = 64.2, SD = 24.79).
Group comparability
The participants were randomly assigned to either the
treatment group (n = 85) or the waitlist comparison
group (n = 79). Demographic data between the
participants in the treatment group and control group
were examined using chi-square analysis and t-tests
87
TABLE 2
Effect Sizes For Subscales Controlling For Pretest Scores
Subscales Constant Treatment differences
effect sizes (d)
Trauma Symptom Inventory Subscales
Anxious Arousal -0.45 *** -1.22 ***
Depression -0.62 *** -1.17 ***
Anger/Irritability -0.39 *** -0.78 ***
Intrusive Experiences -0.4 *** -1.27 ***
Defensive Avoidance -.12 -0.96 ***
Dissociation -0.48 *** -1.09 ***
Sexual Concerns -0.53 *** -0.36 **
Dysfunctional Sexual Behavior -0.45 *** 0.26 **
Impaired Self-Reference -0.49 *** -1.08 ***
Tension Reduction Behavior -0.32 *** -0.6 ***
MPSS
Frequency score -0.6 *** -1.33 ***
Severity score -0.57 *** -1.2 ***
**p <.01, ***p <.001
Note. The constant effect size indicates the impact of non-treatment for the control group. The Treatment
differences effect size indicates the impact of the treatment above the impact on the control group (i.e., in
addition to the constant).
Addendum
A follow-up study of the trained therapists was done one year later. In this study, thirty-ve therapists participated
in interviews. They had treated an average of 37.50 people (SD = 25.37), and they reported that they had
met with each client an average of 3.19 times (SD = 1.08). They had treated from 3 (n = 1, 2.9%) to 123 (n
= 1, 2.9%) people, and they had seen each client from 1 (n = 1, 2.9%) to 6 (n = 2, 5.9%) times (Mode = 3, n
= 14, 41.2%). Thirty-four (97.1%) of the therapists said that TFT had made a difference in people’s lives, and
34 (97.1%) said that people were pleased with the treatment. Data from one therapist were missing for these
questions. Thirty (85.7%) of the therapists said that TFT had beneted the community, and 8 (22.9%) indicated
that the changes in people that were brought about by TFT were contributing to the socio-economic development
of Rwanda. Eleven (31.4%) of the therapists suggested that TFT should be disseminated throughout Rwanda.

African Journal of Traumatic Stress Vol 3 No1 June 2013
88
to ascertain any differences between the two groups.
The treatment group participants ranged in age from
18 to 100 (M =48.3, SD =15.7), and the control
group ranged in age from 21 to 85 (M = 47.2, SD
= 13.9). The treatment group was 91.1% female
(n = 72), and the control group was 81.2% female
(n = 69). The two groups had similar percentages
of participants attaining the PTSD cutoff scores (with
scores indicating PTSD) on the MPSS. See Table 1
for pre-test comparisons.
Treatment outcome
The MPSS and TSI pre and posttests measure
changes in specic trauma symptoms. (The outcome
measures of the TSI and MPSS are unique aspects
of trauma symptomology.) The rst analysis was to
conduct a paired-samples t-test to determine within-
group changes for the treatment and control groups
to determine if there were statistically signicant
differences between the treatment and control
groups. Then, an analysis of covariance (ANCOVA)
was run, controlling for pre-test scores, to determine
the effects of the intervention. To address Type 1
error for multiple testing, α= was set at .01.
Impact of treatment
Signicance tests on posttest means for
each TSI subscale and MPSS scale were done by
means of the F-ratios computed in the ANCOVA
after the adjustment of the group mean to control
for pre-test score. As shown in Table 1, despite the
randomization of the study some of the pretest scores
were signicantly different between the treatment
and control groups. ANCOVA’s of posttest means
were conducted for each TSI subscale and the MPSS
scales by using pretest scores as covariates. The
adjusted posttest scores showed signicant decreases
in trauma symptoms for the treatment group on all
TSI subscales and signicant decreases on the MPSS
frequency and severity scales. See Table 2.
Effect sizes using Cohen’s d (Cohen, 1988)
were calculated with the ANCOVA controlling
for pretest scores to determine the magnitude
of change after the treatment intervention, and
also the magnitude of difference between the
treatment and no treatment control groups. A small
effect is .2, a medium effect is .5, and a large
effect is .8 and above (Dunst, Hamby, & Trivette,
2004). Large effect sizes (from .8 to 1.33) were
found between treatment and no treatment control
conditions on the TSI subscales of Anxious Arousal,
Depression, Anger/Irritability, Intrusive Experiences,
Defensive Avoidance, Impaired Self-Reference, and
Dissociation, as well as the MPSS frequency and
severity scales. High medium (above .60) effect
sizes were found for the Tension Reduction Behavior
subscale. Small effect sizes (.2) were found for the
Sexual Concerns and Dysfunctional Sexual Behavior
subscales. The effect size on the MPSS Frequency
Scale was 1.33 on the Severity Scale, and 1.2 on the
Frequency Scale. See Table 2 for effect size scores.
To determine if there was a signicant impact
of the intervention on the waitlist control group (n =
79), a t-test was run for each trauma subscale on
the TSI and the MPSS scales. Prior to running the
t-tests, the posttest 1 and posttest 2 were adjusted
for pretest differences. The adjusted posttest scores
showed signicant decreases in trauma symptoms
scores on all TSI subscales and signicant decreases
on the MPSS frequency and severity scales. The
Cohen’s d (Cohen, 1988) demonstrated medium to
large effect sizes, demonstrating the magnitude of
change after the treatment intervention.
Both the control group and the treatment
group showed signicant drops in scores on the
TSI and MPSS subscales, which may be partially
due to the testing effect; however, a very strong
treatment effect was found, as demonstrated by the
magnitude of differences between the control and
treatment groups at rst post test, and then signicant
improvement for the control group after treatment.
DISCUSSION
Summary of ndings
The ndings of this randomized controlled
trial support the hypothesis that participants treated
with TFT by trained community leaders showed
trauma symptom reduction greater than those
receiving no treatment, on measures of PTSD-specic
trauma symptoms and the frequency and duration
of PTSD symptoms, seven days post TFT treatment.
In this study, a single TFT session administered by
supervised community leaders, recently trained in
TFT, provided evidence to support earlier ndings
(Connolly & Sakai, 2011; Sakai et al., 2010) that
TFT could be effective in reducing longstanding and
severe symptoms of PTSD. The changes from pretest
to posttest were signicant for the TFT treatment
group and were not signicant for the control group.
The control group showed significant changes,
however, after their subsequent TFT treatment.
The authors of this study are not suggesting
that one session of TFT, administered by community
leaders, can completely resolve severe and long-
standing symptoms of trauma, but advocate
providing community leaders with skills that could be
used to follow up with further treatments as needed
within the community.
Limitations and suggestions for further
research

African Journal of Traumatic Stress Vol 3 No1 June 2013
89
928-282-2627; Fax 928-282-0121. Email smc@
suzanneconnolly.com.
References
Alexander, R. (2010). Human behavior in the social
environment: A macro, national, and International
perspective. Los Angeles, CA: Sage.
American Psychiatric Association. (2000). Diagnostic
and statistical manual of mental disorders (Revised
4th ed.). Washington, DC.
Briere, J. (1995). Trauma Symptom Inventory:
Professional manual. Lutz, FL: Psychological
Assessment Resources.
Callahan, R. J., & Callahan, J. (2000). Stop the
nightmares of trauma. Chapel Hill, NC: Professional
Press.
Cohen, J. (1988). Statistical power analysis for the
behavioral sciences (2nd ed.). Hillsdale, NJ:
Lawrence Earlbaum Associates.
Connolly, S.M., & Sakai, C.E. (2011). Brief trauma
symptom intervention with Rwandan genocide
survivors using Thought Field Therapy. International
Journal of Emergency Mental Health, 13(3), 161-
172.
Desjarlais, R., Eisenberg, L., Good, B., & Kleinman,
A. (1995) World mental health: Problems and
priorities in low-income countries. New York, NY:
Oxford Press.
Dunst, C. J., Hamby, D. W., & Trivette, C. M.
(2004). Guidelines for calculating effect sizes for
practice-based research syntheses. Centerscope:
Evidence-based Approaches to Early Childhood
Development, 3, 1-10.
Falsetti, S.A., Resnick, H.S., Resnick, P.A., & Kilpatrick,
S.G. (1993). The modied PTSD Symptom scale:
A brief self-report measure of Posttraumatic Stress
Disorder. The Behavior Therapist, 16, 161-180.
Folkes, C. (2002). Thought Field Therapy and trauma
recovery. International Journal of Emergency
Mental Health, 4, 99-103.
Galea, S., Nandi, A., & Vlahov, D. (2005). The
epidemiology of post-traumatic stress disorder
after disasters. Epidemiological Reviews, 27(1),
78-91. Retrieved from http://ojs.lib.swin.edu.au/
index.php/ejap. doi:10.1093/epirev/mxi003
Ghosh, N., Mohit, M., & Murthy, R. (2004). Mental
health promotion in post-conict countries. The
Journal of the Royal Society for the Promotion of
Health, 124(6), 268-270.
Greenwald, R., & Rubin, A. (1999). Brief assessment
of children’s posttraumatic symptoms: Development
The effect sizes found in this study and
the Connolly and Sakai (2011) study need to be
substantiated with comparative studies utilizing
placebo treatments and traditional PTSD treatments.
The study participants were volunteers from one region
of Rwanda who were informed of this study, and
had access to participate. The outcomes may not be
generalizable to all Rwandans or other war survivors.
Clinical implications and conclusion
Prolonged and intense PTSD, due to conict
and natural disasters, affects large segments of
the population throughout the world. Mental health
needs frequently far outstrip mental health resources.
Findings from this study suggest that brief treatment
using TFT treatments provided by trained community
leaders shows promise as an effective method of
alleviating symptoms of trauma after large-scale
traumatic incidents.
Enlisting community leaders to treat fellow
community members employing an effective brief
therapy intervention that does not require years of
clinical training vastly enhances the potential mental
health care resources in a community devastated by
wide scale trauma, and is consistent with guidelines
formulated by ISAC (2007) (Ghosh et al., 2004).
ACKNOWLEDGEMENTS
The Association of Thought Field Therapy
Foundation funded this study through contributions from
the Ruth Lane Charitable Foundation, the Linden Root
Dickinson Foundation, the PepsiCo Foundation, and
individual donors.
The authors want to thank Father Jean Marie
Vianney Dushimiyimana, Father Augustin Nzabonimana,
Bishop Servilien Nzakamwita, the therapists, and the
Rwandan participants who made this study possible.
They also wish to thank the members of the Rwandan
National Ethics Committee for their suggestions and
guidance. They want to thank team members, Gary
and Cynthia Quinn of Haleiwa, Hawaii; Carmen Luz
Carrasco of Juarez, Mexico; and Gordon Barrett of
Musgrave, Australia. Special thanks go to Arizona
State University statistician, Eric Hedberg, who devoted
many hours of guidance related to the statistics
reported in this study.
By way of disclosure of potential conicts of
interest, three of the authors use Thought Field Therapy
in their private practices and conduct workshops on
using Thought Field Therapy.
Correspondence about this article should
be addressed to Suzanne M. Connolly, LCSW, 70
Payne Place, Suite 6, Sedona, Arizona, 86336. Phone

African Journal of Traumatic Stress Vol 3 No1 June 2013
Guidelines on mental health and psychosocial
support in emergency settings. Retrieved
from http://www.who.int/mental_health/
emergencies/guidelines_iasc_mental_health_
psychosocial_june_2007.pdf
Sakai, C., Connolly, S., & Oas, P. (2010). Treatment
of PTSD in Rwanda genocide survivors using
Thought Field Therapy. International Journal of
Emergency Mental Health, 12(1), 41-49.
Weathers, F.W., Huska, J.A., & Keane, T.M. (1991).
PCL-C for DSM-IV. Boston, MA: National Center
for PTSD Behavioral Science Division.
World Health Organization, Department of Mental
Health and Substance Dependence. (2003).
Mental health in emergencies: Mental and social
aspects of health of populations exposed to
extreme stressors. Retrieved from http://www.
who.int/mentalhealth/media/en/640.pdf
90
and preliminary validation of parent and child
scales. Research in Social Work Practice, 9,
61-75.
Hobfoll, S.E., Watson, P., Dell, C.C., Bryant, R.A.,
Bymer, M.J., Friedman, M.J., & Ursano, R.J.
(2007). Five essential elements of immediate
and mid-term mass trauma intervention: Empirical
evidence. Psychiatry, 70(4), 283-315.
Neugebauer, R., Fisher, P.W., Turner, J.B., Yamabe,
S., Sarseld, J.A., & Stehling-Ariza, T. (2009).
Post-traumatic stress reactions among Rwandan
children and adolescents in the early aftermath
of genocide. International Journal of
Epidemiology, 38(4), 1033-1045. Retrieved
from http://ije.oxfordjournals.org/cgi/content/
full/38/4/1033
Inter-Agency Standing Committee (ISAC). (2007).